In Time: Enteral Nutrition for Preterm Infants: so Much Learned, but We Still Don’t Know How to Best Feed Them

Neonatology is a fast progressing science that revolutionized the care of preterm neonates. The past four decades provided us with the necessary technology and specific knowledge to prevent and treat respiratory distress syndrome, bacterial infection, hypoxic‐ischemic encephalopathy and operable congenital anomalies in these infants. Interestingly, enteral nutrition support for the preterm neonate remains as a significant therapeutic challenge. The newborn nutrition research has been mostly focused on addressing the requirements and the adequate balance of paren‐ teral and enteral nutrition components, in order to promote postnatal growth that is similar to the intrauterine one.1 This has led to improved parenteral nutrition preparation, specialized preterm formulas, milk fortifiers and nutritional supplements that enable clinicians to currently treat the special needs of extremely premature infants. Yet, one of the most common nutritional support challenges when it comes to caring for the preterm infant population is the presence of feeding intolerance.2 It is awkward to admit that the language commonly used amongst neonatal health care workers reflects our ignorance on the subject. A common interaction between a neonatal intensive care unit (NICU) nurse and the physi‐ cian is best illustrated as follows. • Nurse (often running after the physician holding a large syringe filled with some disgusting milk like fluid): Look at what I aspirated from that baby’’s stomach. What do you want me to do now? • Physician: I do not know. How is the baby doing otherwise? • Nurse: The baby looks fine and this is the first time today that I aspirated this much from her stomach. • Physician: Well, just hold a feed and then resume at 50% of the feed volume to see what happens.